Stepping Up to be a Step Ahead: Team Development in the Cath Lab

Working for Corazon, a national firm niched in heart and vascular services, gives us the opportunity to have an insider’s view on many cardiac catheterization labs in all types of hospitals across the United States. As we build new or assess existing labs, we notice that each has its own set of challenges, though each also has unique achievements as well. Over time, we have seen that in order for any lab to be successful, team members need to “step up” not only individually, but also as a department or program overall. In this article, we will discuss recommendations for improvement that should keep you, your team members and your department a step ahead of the rest. Key Players: The cardiac cath lab (CCL) team is usually a mix of nurses, technologists and other ancillary staff. While each brings knowledge based on their clinical education and work experience, the challenge is functioning as an integrated team with interchangeable members. We believe that ideally, the team should be cross-trained in the roles and responsibilities of others, unless, of course, state law prohibits this practice. Key Activities: “Stepping up” for the clinical staff means understanding the “business” of care delivery, which can no doubt have a positive impact across the department. When Corazon works with organizations, we can easily identify staff members who are taking steps to pursue higher goals — such as a role in management or in education — or those who are happy with their current clinical position. Regardless of their motivation level, each team member should know what will make a difference in terms of program or personal success. Job descriptions should drive individual contributions, and can be used as a basis for advancement. Personal and professional goals should be matched to a clear plan for career advancement, and should be tied to the overall goals and objectives of the cath lab, department and/or hospital. A solid clinical skill set, along with an understanding of key business concepts, results in a well-rounded approach to the job. Level 1 – Understanding Cath Lab Financials CCL personnel are usually not entry-level practitioners. Most have had experience and are fine-tuning skills that have originated in other areas of the hospital. With this clinical framework as a base, understanding financials helps employees focus on the hospital’s need to continually balance cost and quality. Often, a “gap analysis” for professional development can determine what areas need to be reviewed. The financial aspects of the department, such as the process that occurs for payment, are often unfamiliar to the clinical team. However, understanding charges, the department-specific payer mix, and how payers are reimbursing goes above and beyond standard clinical knowledge, and as a result, will better prepare employees to understand the challenges of program growth, profitability and sustainability. The clinical team should also investigate whether any denials or delays in payment can be attributed to flaws in departmental processes and what can be done to proactively change the outcome in the future. Mechanisms to cross-check are important as well. The team also needs to understand the lab as a cost center and what helps (rather than hurts) profitability. Accountability with such items is not just the responsibility of management, but rather that of the whole team. For instance, errors in coding or charge capture alone can cost an organization thousands of dollars each year. The caregivers (i.e., the cath lab staff) standing side-by-side with the cardiologists at the procedure table can be a first-line approach to ensure appropriate clinical documentation capture. Members can even educate the team about the ability to appropriately document the complexity of patients’ conditions, which ultimately drives hospital payment. Since errors or omissions leave dollars on the table, educating staff on the financial side of the business will not only benefit the department, but will inspire staff to broaden their skills and perspective. Encouraging team members to focus on more than just their clinical areas of expertise can indeed influence positive change — both clinically and financially. Level 2 – Seeking a Business Education Clinical staff need to gain confidence that they CAN understand the business aspect of care, and SHOULD be motivated to do so through informal or formal education that covers topics outside their typical comfort zone. We believe this education should be a mixture of both internal and external experiences. External can involve online courses or participation in professional societies such as the Healthcare Financial Management Association (HFMA), while internal education can take various forms. For instance, if the department has a financial dashboard, team members should learn the positive and negative indicators of financial performance and what they can do to correct any identified issues. Clearly, staff who are able to analyze, balance, and integrate cost and quality data make better decisions about performance improvement and look for new ways to achieve excellent outcomes. An individual’s ability to use other departments as internal experts can assist in the creation of a learning culture. If the department has access to a financial liaison/analyst, staff should have formal and informal ways be able to direct questions to this person to further develop a knowledge base that allows everyone to learn, grow, and ‘step up.’ Level 3 – Expanding Clinical Knowledge Staff may especially struggle to learn business concepts because it is crucial that they remain patient- and quality-focused while continuing to advance their clinical skill set. Development of a clinical skill set is even more important if the department is moving towards the implementation of a new procedure such as coronary interventions, electrophysiology, and/or vascular work. For example, electrophysiology (EP) is one of the fastest growing sub-specialties within cardiology — a specialty that requires experienced physicians, specialty nurses and techs. When starting or growing an EP program, experienced staff are essential. The fundamentals required to obtain competency in an EP lab must be supported by educational programming as well as clinical observation and experiences. A program can look externally for seasoned employees or work to develop the skill set of current staff via various means. Another area of growth within the cath lab is the staff role in performing vascular procedures. The hybrid suite allows for endovascular, carotid stenting and peripheral interventions to take place in the same area. This new layout challenges CCL personnel to learn new techniques, explore new vascular territories, and master new devices and technology. In-services that include physician experts and vendor representatives can be invaluable when implementing a new technology or investigating a new product or procedure. These forums can ensure staff is able to voice their concerns, seek clarifying details, and reach a depth of understanding and increased comfort level. Team members and management need to be proactive to ensure that various types of training are frequent and relevant, especially in the case of new service implementation. Level 4 – Expanding Organizational Knowledge Staff should be intimately knowledgeable about their program’s policies and procedures, and should ensure consistency in the application of these policies and procedures at all times. A team to regularly review policies and ensure consistency will help to ensure that manuals are correct and up-to-date. Collaboration with physician leaders in these reviews works well to capture multiple perspectives. This approach will also give the team insight to how much time and effort goes into writing policies and keeping them current. Policies written with standardization as a backdrop can assure consistent practice, meaning consistent clinical and financial outcomes. Level 5 – Developing Interpersonal Skills Those on a CCL team function very differently than bedside nurses. While the nurses function independently for a majority of the day, cath lab staff must continually work together in a team environment. Therefore, interpersonal skills become essential to a highly functioning group. Team members should be focused on developing communication skills, positive team dynamics and a flexible approach for handling issues. Mechanisms for dealing with conflict between staff and management and among staff peers should be clearly articulated, with expectations for conflict resolution and team accountabilities outlined and utilized. Relationships with physicians are equally important to a well-functioning CCL. Team members should be knowledgeable about each participating physician’s skill set and associated privileging in the CCL setting. It is often helpful for team members to share lessons learned to facilitate understanding of what dynamics work well with one particular physician versus another. If a clinical medical director is appointed, the team should understand the role of the medical director and how this medical staff leader can help address clinical issues, physician relationship issues and practice variability issues. So, is your program stepping up or just keeping in step? Ongoing team development is essential to a top-performing cath lab. Best-practice teams are not frightened by change, but rather choose to embrace the opportunity and challenges associated with learning new procedures, expanding clinical skill sets and their associated knowledge base, as well as developing the staff interdependencies that accompany cross-training. The old adage that you are only as strong as your weakest link is one that resonates, particularly when we encourage our client cath labs to complete an education/skills gap analysis. A solid departmental education schedule and individual professional development plans are an essential foundation for a well-trained, collaborative and motivated team. The excitement of working with individuals and teams who reject the status quo and enthusiastically accept the challenge to step up is contagious. Leadership must support the notion of continuous learning, which can strengthen retention, increase work satisfaction and result in happier faces in your workforce.

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